Seaview is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate 20 people in one adapted building. At the time of our inspection 17 people with physical and mental health related conditions were using the service.This unannounced comprehensive inspection took place on 16 and 17 January 2018. This means that neither the provider nor the staff at Seaview knew we would be visiting the home. At the last inspection in November 2016, we identified breaches of regulations which related to safety, consent and the governance of the service. We found improvements had been made in most areas but not enough to ensure compliance with all of the statutory requirements.
This is the second consecutive time that this service has been rated as 'requires improvement'.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions safe, effective, responsive and well-led to at least good. An action plan was sent to us by the registered manager in February 2017 which showed that the majority of required actions were completed and that any outstanding actions had a defined target date of 28 February 2017.
However, at this inspection we found that although the registered manager and the deputy manager had made improvements throughout the service, the governance was not robust enough to fully identify or completely address some of the continued issues we highlighted during this visit.
We found record keeping continued to require improvement. In particular, medicine administration records and clinical care plans required some attention to ensure comprehensive detail was included in respect of all people, their needs and specific risks they may face due to their health conditions. We have made a recommendation about this.
The provider has failed to display their previous performance assessment as legally required. We are dealing with this matter outside of the inspection process.
There was a well-established registered manager in post; however they were on annual leave at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The deputy manager, who was also the lead nurse, assisted us in the registered manager’s absence.
People told us that they felt safe living at Seaview with the support from staff. There were safeguarding policies and procedures in place. Staff were knowledgeable about what action they should take if they suspected abuse. The local authority safeguarding team and commissioning teams informed us that were no current concerns about this service.
Records relating to accidents and incidents were kept including matters of a safeguarding nature. Incidents were recorded, investigated and reported in a timely manner to other relevant authorities such as the local authority or CQC.
The service managed general risks associated with the health and safety of people, including the completion of regular checks of the property, equipment and utilities in line with their legal responsibilities. People’s individual care needs had been assessed for risks related to daily living; however some clinical care plans did not describe specific risks related to health conditions such as epilepsy. Care records had been reviewed and updated on a monthly basis.
Medicines were stored in a safe and secure place. The staff followed policy and procedures regarding the ordering, receipt, storage, administration and disposal of medicines. We found that medicines were administered safely and when people needed them however, record keeping around medicine administration required improvement to ensure it was more detailed.
Staff records showed the recruitment process was robust and staff had been safely recruited. Training was up to date, and the staff team were supported through supervision and appraisal sessions. There were sufficient numbers of staff deployed to meet people’s needs.
The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Applications had been made on behalf of some people to restrict their freedom for safety reasons in line with the Mental Capacity Act 2005. All staff now demonstrated an understanding of the MCA and worked within its principals, including gaining consent to care for people who lacked mental capacity.
The service involved external health professionals as necessary to meet people’s needs and to support their general health and well-being. People’s specific nutrition and hydration needs were met. We saw people enjoyed a variety of meals prepared by the cook. People were given a choice around mealtimes.
The care plans in place were very person-centred. People’s individual needs were assessed and continuingly reviewed and an appropriate and current plan of care was in place.
We saw all staff treated people with dignity and respect. They displayed friendly, kind and caring attitudes and people told us the staff were nice to them. We observed people enjoying pleasant relationships with staff and it was evident they knew each other well.
Staff had plenty of time to provide a wide variety of stimulating activities which people enjoyed. One-to-one and group support was available to people to reduce social isolation and meet their social, cultural and religious needs. Visitors were welcomed into the home at any time.
The service had received four complaints since our last inspection. We saw that the registered manager investigated and managed complaints thoroughly and in a timely manner. The complaints procedure was on display and had been shared with people who used the service and their supporters. The service had received a large amount of compliments and ‘Thank you’ cards.
Regular quality assurances checks were undertaken by the registered manager. The deputy manager and nursing staff also checked daily, weekly and monthly care monitoring tools and medicine administration records to monitor the quality of care people received and to check it was appropriate to their needs On some occasions, actions had not been fully recorded to show what action had been taken to address issues highlighted in audits, although we found this had no impact on the service people received.
A recent annual survey had been issued to gain the opinion of people and relatives about how the home was managed and how it could be improved. We found the service had received a positive response to the questions asked which the registered manager had evaluated. Staff spoke highly of working for the organisation and the registered manager and they told us they felt valued and appreciated.
We found one breach of the Health and Social Care Act 2008. This related to Regulation 17: Good Governance. You can see what action we told the registered provider to take at the back of the full version of this report.